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							<a href="" class="link">Where to Buy</a>
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					<p class="p1"><span class="span1">Jion us</span><span class="span2">On Line Application</span></p>
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					<a href="" target="_blank">RESELLER APPLICATION</a>
					<a href="" target="_blank" class="cur">INSTALLER CERTICIFCATION</a>
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				<div class="info_block">
					<div class="info_head">
						<div class="info_logo fl"><img src="./images/21.png"/></div>
						<div class="info_title fl">Installer Cetificaltion</div>
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						<div class="photo"><img src="./images/22.png"/></div>
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					<div class="info_body">
						<div class="cnt">
							<form class="form_mod"  id="Installer_form" name="Installer_form">
								<ul>
									<li>
										<label for="company" class="label"><em>*</em>Company Name</label>
										<input name="txtCompanyName" type="text" class="text company required"  />
									</li>
									<li>
										<label for="contact" class="label"><em>*</em>Contact Name</label>
										<input name="txtContact" type="text" class="text contact required" />
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										<label for="email" class="label"><em>*</em>E-mail Address</label>
										<input name="txtEmail" type="text" class="text email required" />
									</li>
									<li>
										<div class="fl">
											<label for="phone_01" class="label"><em>*</em>Phone Number</label>
											<input name="txtPhone1" type="text" class="text phone required" />
										</div>
										<div class="fl">
											<label for="phone_02" class="label">Phone Number2</label>
											<input name="txtPhone2" type="text" class="text" />
										</div>									
									</li>
									<li>
										<label for="address" class="label"><em>*</em>Address</label>
										<input name="txtAddress"  type="text" class="text required"/>				
									</li>
									<li>
										<div class="fl">
											<label for="city" class="label"><em>*</em>City</label>
											<input name="txtCity" type="text" class="text city required" />
										</div>
										<div class="fl">
											<label for="state" class="label"><em>*</em>State/Province</label>
											<input name="txtState" type="text" class="text state required" />
										</div>									
									</li>
									<li>
										<div class="fl">
											<label for="postal" class="label"><em>*</em>Zip Code</label>
											<input type="text" class="text postal required " name="txtPostal" />
										</div>
										<div class="fl">
											<label for="country" class="label"><em>*</em>Country</label>
	                    <select class="text"  name="txtCountry">
	                      <option value="USA" selected="selected">USA</option>
	                      <option value="Canada">Canada</option>
	                      <option value="International">International</option>
	                    </select>
										</div>									
									</li>
									<li>
										<label for="InstallationArea" class="label"><em>*</em>Installation Area:</label>
										<select class="text"  name="txtInstallationArea">
							        <option value="" selected="selected">Please Select</option>
	                    <option value="Local">Local</option>
	                    <option value="Statewide">Statewide</option>
	                    <option value="Regional">Regional</option>
	                    <option value="National ">National </option>
	                   </select>
									</li>
									<li>
										<label for="how" class="label"><em>*</em>How did you learn about SureCall</label>
										<select class="text"  name="txtLearn">
							        <option value="" selected="selected">Please Select</option>
	                      <option value="Web search">Web search</option>
	                      <option value="Online ad banner">Online ad banner</option>
	                      <option value="Bolg/Online Product Review">Blog/Online Product Review</option>
	                      <option value="Refer">Refer</option>
	                      <option value="Magzine">Magzine</option>
	                      <option value="Tradeshow">Tradeshow</option>
	                      <option value="In the News">In the News</option>
	                      <option value="Direct Mail">Direct Mail</option>
	                    </select>
									</li>
									<li>
										<div class="fl">
											<label for="city" class="label"><em>*</em>Number of Locations</label>
											<input type="text" class="text city required" name="txtLocations" />
										</div>
										<div class="fl">
											<label for="state" class="label"><em>*</em>Number of Employees</label>
											<input type="text" class="text state required" name="txtEmployees" />
										</div>									
									</li>
									<li>
										<label for="company" class="label"><em>*</em>Years of Installing Cellular Amplifiers</label>
										<input type="text" class="text company required" name="txtExperience" />
									</li>
									<li>
										<label for="company" class="label"><em>*</em>If so,which brand</label>
										<input type="text" class="text company required" name="txtwhich" />
									</li>	
									<li>
										<label for="company" class="label"><em>*</em>Security Code</label>
										<input type="text" class="text required" name="txtCaptcha" id="txtCaptcha" CssClass="inp_text" Text="" style="width:100px;" />
	                  <img src="./images/captcha.png" id="captchaImage" style="cursor: pointer; margin-left:4px;height:23px;width:70px;vertical-align: middle;display: inline-block;" />
									</li>
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								<div class="form_btn clearfix">
								<input id="btnSubmit" type="submit" value="Submit" />
								</div>
							</form>
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				<div class="center_block">
					<a href="" class="joinUs_menu1">Why SureCall</a>
					<a href="" class="joinUs_menu2">Term & Condition</a>
					<a href="" class="joinUs_menu3">Product Catalog</a>
					<a href="" class="joinUs_menu4">Reseller Store</a>
					<a href="" class="joinUs_menu5">Reseller Resource</a>
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			<a href="javascript:;" class="toTop"><img src="./images/48.png"/></a>
			<a href="" class="posa_bar1">VEHICLE</a>
			<a href="" class="posa_bar2">HOME</a>
			<a href="" class="posa_bar3">ENTERPRISE</a>
			<a href="" class="posa_bar4">M2M</a>
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					<p>© 2016 SureCall  All Rights Reserved</p>
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				<form action="" method="post">
					<input type="text" name="username" id="username" autocomplete="off" placeholder="UserName" />
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					<input type="submit" name="login" id="login" value="login" />
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